Mental health now an ‘essential’ benefit in Affordable Care Act

Andrew Mackay pays $454 a month for mid-range health coverage. The 23-year-old Menlo Park resident does not smoke, he is not obese, and his blood pressure is normal. He said his insurance costs so much because he was diagnosed with a bipolar condition at age 15.

Before Congress passed the Affordable Care Act, Mackay worried that his future in the health insurance system would be “terrifying” due to his pre-existing condition. Now that he’s able to stay on his parents’ plan until he is 26 and get a significantly lower rate ($309 a month), he said, “I feel transitioning into my twenties is doable. It’s not as imposing as it was.”

Mackay is one of about 1.2 million California adults who live with some form of mental illness. Nationwide, the numbers are staggering. “In any given year, one in five adults experience a mental illness,” President Obama said at the National Conference on Mental Health in June. “Forty-five million Americans suffer from things like depression or anxiety, schizophrenia or PTSD. … Today, less than 40 percent of people with mental illness receive treatment.”

“Pre-Existing Condition: A health problem you had before the date that new health coverage starts.” –HealthCare.gov

Nancy Pena, the director of the Santa Clara County Mental Health Department, explained that “individuals will have more choice regarding the plan they want, the coverage they receive and the providers they want.”

Under the ACA, health plans are required to cover preventative services, including behavioral assessments for children, at no additional cost. Coverage will also include behavioral health treatment, such as psychotherapy, and substance abuse treatment – both for inpatient and outpatient care.

Stephen Kaplan, the director of San Mateo County Behavioral Health and Recovery Services, at the San Mateo County Mental Health and Substance Abuse Recovery Commission meeting in November. (Vjeran Pavic/Peninsula Press)

Building on the Mental Health Parity and Addictions Equity Act, the ACA requires insurers to guarantee that financial requirements like co-pays and deductibles, as well as limits on doctors’ visits and care management, are no more restrictive in the behavioral health field than requirements or limitations on other medical or surgical benefits.

“This is really a very significant part of the ACA for us,” said Stephen Kaplan, the director of San Mateo County Behavioral Health and Recovery services.

San Jose-based Marriage and Family Therapist Irene Capuchino agreed. “Mental health needs have been seen as a secondary or even luxury add-on,” she said. “The stigma around receiving mental health therapy, or the belief that ‘good’ or ‘intelligent’ or ‘normal’ people never need mental health treatment negatively impacts our collective ability to even acknowledge the need for mental health services. Hopefully the ACA’s parity clauses will be a beginning step towards acknowledging and appreciating the value of mental health treatment services for people who need them.”

Specific behavioral health benefits vary from state to state. According to the National Alliance on Mental Illness, California offers limited parity and covers serious emotional disturbances in children and severe mental illness for all patients.

“A serious mental illness, a categorization for adults age 18 and older, is any mental illness that results in substantial impairment when carrying out major life activities.” –California HealthCare Foundation

Irene Capuchino, a marriage and family therapist based in San Jose. (Photo courtesy of Irene Capuchino)

Kaplan said the Affordable Care Act will not make a large difference for the seriously mentally ill. Those who fit the legal definition of severe mental illness already qualify for disability. Those who struggle with substance abuse, on the other hand, laud provisions in the ACA that classify substance abuse treatment under the umbrella of mental health.